Why you should care
Most Western democracies offer universal health care. But in the land of the free? Not so much.
Our question this week: Should all Americans be entitled to health care? Email us or comment below with your thoughts.
Aaron Katz, principal lecturer in health services at the University of Washington, weighs in:
Life, liberty and the pursuit of happiness: Those “inalienable rights” are perhaps the most famous phrase of the Declaration of Independence. They define the bedrock idea of “America,” a place where anyone (OK, ignoring for the moment that the authors of these words did not believe women, African-Americans or Native Americans were worthy of such rights) should have the opportunity to pursue their own paths.
How do these rights show up in our lives? Let’s look first at the “pursuit of happiness” — the ability to live one’s chosen life fully. Education is a basic ingredient to a child’s ability to succeed in life and be an informed citizen. So, we both require a basic level of schooling for all children and fund a public system to ensure that all children, regardless of background or circumstance, can get that schooling.
Just as we know that our house is protected if all houses are protected, our health and well-being are dependent upon everyone else’s.
And “liberty”? The U.S. Constitution, and many state constitutions, enhances our freedom by limiting government actions (e.g., banning unauthorized searches and protecting speech) and banning unacceptable private behavior (e.g., discrimination on the basis of race, ethnicity or gender).
“Life”? One aspect of this inalienable right is safety — safety on the roads, safety at work and safety of our homes. Essentially every dwelling in the United States is protected from fire by a fire department. A home fire is a threat to the ability of a family to live, and we know that if our neighbor’s house is on fire, our house is also at risk. So we want every house to be protected: Assuring everyone’s right to safety (“life”) assures our own.
Health care is as necessary as safety. We need to be able to function physically and mentally, as free as possible from illness and injury, to live a life of meaning — to learn, work and participate in community. This ability to function is necessary regardless of individual life circumstances, whether we are rich or poor, young or old, city-dwelling techies or ranchers, teachers or mechanics.
Just as we know that our house is protected if all houses are protected, our health and well-being are dependent upon everyone else’s. A short-order cook who goes to work with the flu because he can’t afford to see a doctor puts co-workers and diners at risk of getting sick. A child who goes unimmunized because her parents fear the costs of a clinic visit puts her classmates at risk. And the care of an uninsured motorist who is injured in an accident is borne by the rest of us.
Saying that health care is a “right” doesn’t necessarily mean that government needs to provide it. But here again, the fire-protection analogy is instructive. Competing, private fire agencies existed in some American cities early in our history, but communities soon learned the dangers of leaving this fundamental right to the market, as firefighters refused to respond to fires at buildings they did not “cover.” Today we know implicitly that wherever we live, a fire department — a public agency funded by taxpayers — will be there to protect us. We don’t fill out eligibility forms or choose among optional plans; we get this protection because we live there.
In the same way, we have ample evidence that public health care systems are simpler, more efficient and more effective. Look at the ongoing debates about the Affordable Care Act, or Obamacare. The ACA continued America’s reliance on the private market and so, to get more people insured and make health care more affordable, the law had to create or expand upon a dizzying array of eligibility rules, subsidies, insurance regulations and administrative agencies, each one different for people with different incomes, different ages, different insurance plans and in different states. In their efforts to repeal Obamacare, the Republicans in Congress have tied themselves in knots trying to disentangle these intertwined, duplicative systems.
Compare the “American way” with most Western industrialized health care systems in which getting needed care is viewed as one of government’s basic responsibilities. The latter have proven to be simpler (less bureaucratic) and less expensive — and often provide better care.
Flowing from the Declaration of Independence, health care is a very American right. If we treated it as such, we could have a much more effective, efficient and fair health care system.